DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

SCHOOL AGE INSPECTION REPORT
Facility Information

YMCA-FOUR RIVERS BRANCH-MARTHASVILLE ELEMENTARY

000978858

(636) 231-2650

800 E MAIN
MARTHASVILLE
MO  63357

GATEWAY REGION YOUNG MEN'S CHRISTIAN ASSOCIATION

400 GRAND AVE
WASHINGTON
MO  63090

PENNOCK, DALLAS JORDAN

dallas.pennoch@gwrymca.org

Incorporated

JOY LYNN NICHOLS

5 YEARS - 12 YEARS

32

SCHOOL AGE

 
Inspection Information

04/18/2018

2:50 PM

3:39 PM

UNANNOUNCED

COMPLIANCE MONITORING

2329507179


DocumentDocument-Date
STAFF SHEET 10/04/2017
EQUIPMENT LIST 10/04/2017
APPLICATION 09/01/2017
CERTIFICATE OF GOOD STANDING 12/14/2015
JOB RESPONSIBILITIES 11/09/2015
LINES OF ADMINISTRATIVE AUTHORITY 12/14/2015
SAMPLE FORMS 11/09/2015
SAMPLE WEEKLY MENU 11/09/2015
DAILY SCHEDULE 11/09/2015
DIRECTOR'S QUALIFICATIONS 12/01/2015
POLICIES 12/01/2015
REGISTERING FICTITIOUS NAMES 12/14/2015
DISCIPLINE POLICIES 12/01/2015
ARTICLES OF INCORPORATION 12/01/2015
DIRECTOR'S JOB RESPONSIBILITIES 12/01/2015




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 1
NOTE
The licensee is responsible for compliance with all licensing rules, including but not limited to the rules listed on this compliance report form.
Attendance at Time of Inspection
Total Staff 2
Total Children 16
StaffChildClass AgeNote
2 16 SCHOOL AGE Patty and Cindy

 
19 CSR 30-62.032 Organization and Administration
Compliance
19 CSR 30-62.042 Initial Licensing Information
Compliance
19 CSR 30-62.052 License Renewal
Compliance
19 CSR 30-62.082 Physical Requirements of Group Day Care Homes and Day Care Centers
Compliance
19 CSR 30-62.090 Disaster and Emergency Preparedness
Compliance
19 CSR 30-62.092 Furniture, Equipment and Materials
Compliance
19 CSR 30-62.102 Personnel
Compliance
19 CSR 30-62.112 Staff/Child Ratios
Compliance
19 CSR 30-62.122 Medical Examination Reports
Compliance
19 CSR 30-62.132 Admission Policies and Procedures
Compliance
19 CSR 30-62.172 Emergency School Closings
Compliance
19 CSR 30-62.182 Child Care Program
Compliance
19 CSR 30-62.192 Health Care
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by one immunization record(s) was/were not on file .
Licensing Rule Reference
19 CSR 30-62.192 Health Care (4) (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.
Correction Required
Child immunization requirements shall be on file as required.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-62.202 Nutrition and Food Service
Compliance
19 CSR 30-62.212 Transportation and Field Trips
Compliance
19 CSR 30-62.222 Records and Reports
Compliance
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
Compliance